Mississauga Chiropractor Presents: Slipped Capital Femoral Epiphysis

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Here’s another blog from a Mississauga Chiropractor…

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A slipped capital femoral epiphysis (SCFE) is a condition where the femoral epiphysis is displaced posteriorly & inferiorly due to weakness in the epiphyseal growth plate.  The slippage causes the femur to adduct & externally rotate causing a decreased abduction & internal rotation range of motion.

 

Demographics

  1. Incidence is 1:100,000
  2. Age:  10-16 years old (usually just after onset of puberty)
  3. Gender: males > females (usually overweight)

 

Causes are unknown, some predisposing factors include:

  1. Rapid growth years of males (rapid growth will widen the physis causing weakness)
  2. Left hip is more often affected but also has bilateral involvement in 20%-25% of the cases
  3. Tends to affect long, slender rapidly growing people, however can be seen in overweight underdeveloped adolescent males

 

History:

  1. May start with mild hip discomfort & pain referral to medial thigh & knee region
  • Only  about 50% of the patient with hip pain & about 25% with knee pain

 

  1. Pain increases with use & decrease with rest
  2. Often of non-traumatic origin (trauma with weight-bearing will increase slippage)
  3. Severe pain associated with sudden displacement

 

Observations:

  1. Mild limp or awkward gait with the affected foot turned out with an externally rotated & adducted thigh
  2. May have a short leg on the involved side
  3. Range of motion:
    1. Internal rotation & abduction is limited; causes increased pain
    2. Thigh shifts towards abduction & external rotation when passively flexed

 

Management:

  1. Refer to an orthopaedic surgeon for consult because a slipped capital femoral epiphysis has a high propensity for morbidity (avascular necrosis of the head of the femur may result if the head of the femur is manipulated)
  2. Avoid weight bearing with bed rest and/or crutches
  3. Surgery is the preferred treatment because it prevents further slippage
  4. Pain is relieved in 4-6 weeks following surgery; gradual return to full activity as tolerated

 

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